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Message: Do Something Real for Health Care

By Eric R. Columbus


Spooked by Pat Buchanan's strength in the New Hampshire polls, George Bush stumbled through January feebly intoning his compassion for the plight of recessionwrecked Americans. In one notably blah speech, he accidently began reading the above stage direction.

[Message: read your speeches before hand.]

But now the slumbering domestic-policy beast has awakened. Last week, in Cleveland, Bush unveiled his plan for revamping the nation's beleaguered health care system. For his efforts he was greeted by a resounding chorus of "boos," some emanating from his own party.

The Bush plan would give poor families vouchers redeemable for up to $3750 of medical insurance and provide tax credits for families that purchase coverage if their annual income is under $80,000. In addition, Bush would ban "cream-skimming," she peculiarly named practice which enables insurers to deny coverage to high-risk clients.

What's this? Bush want to expand health coverage to cover the uninsured? And he's going to force those big bad insurance companies to stop shafting people with serious health problems? Is this George Bush or George McGovern?

Don't believe the hype. The Bush plan is an incomplete, inefficient proposal that would only exacerbate America's health care woes. What seems like a good liberal plan is actually a prescription for ruin.

NO ONE LIKES our current health care system: it costs too much to provide too little care for too few. As a nation we spent $666 billion on health care last year, a whopping 14 percent of our gross national product. And 35 million Americans have no health insurance whatsoever.

Bush says his plan would cost $100 billion over the next five years--most of that money going straight into the hands of insurance companies reaping huge windfalls from the additional clients made possible by the voucher plan. Where's the cash coming from, George? "We'll figure that out," says the President.

Who cares about costs? Can we put a price on good health? We better before our economy goes into intensive care. The current rate of health care costs is "threatening to consume an impossible proportion of the gross domestic product." That's not a Bush critic talking. Those are the words of the President's own budget director, Richard Darman.

Bush criticizes Democratic plans as "socialized medicine." Although that phrase does sound vaguely pernicious, the only way to contain costs is for the government either to set spending limits or dictate the terms under which private plans would compete.

This requires either a "pay-or-play" scheme, forcing businesses to provide coverage for their workers or to pay into a government fund of the otherwise uninsure, or a Canadian style national health insurance system in which the government pays nearly all health costs. Democratic presidential candidates Bill Clinton and Paul Tongs favor the first approach. Jerry Brown and Bob Kerrey supports the second. (Tom Harkin is still on the fence).

Containing costs requires higher taxes. But don't be fooled--we already pay health "taxes"--we just pay them to private insurers instead of the government. If the government were actively employed to hold down costs, we'd send a bigger slice of our paychecks to Washington, but we'd get back more in return by writing smaller checks--or no checks at all--to insurers.

The President claims that his plan "insures choice"--an uncontroversial goal. But the Bush plan actually works to limit choice by encouraging the use of "managed care" and health maintenance organizations (HMOs) which hold down costs by restricting their client's choice of doctor and hospital--and often limit doctors' options as well.

What's the best way to guarantee choice? The President's nemesis, "socialized medicine." In Canada, anyone can walk into any doctor's office or any hospital. Not so here.

Bush's plan is extremely odd. As Jerry Brown would say, there's certain unreality here. Bush goes to great lengths to expand the options for uninsured Americans but does little to help keep down costs. He aims to reduce the "paperwork blizzard" of health care administration but adds another layer of bureaucracy through the voucher system. He triumphs choice of doctor but advocates HMOs.

PERHAPS BUSH'S PLAN is just a ruse. As Yogi Berra might say, the President may be dumb, but he isn't stupid. He knows his plan is too silly to pass. He knows that most Democrats favor more radical reform. But now his name is no the health care scoreboard, blunting a potent Democratic weapon. His gambit is that voters will be too confused by the intricacies of health care reform to be able to distinguish between rivaling plans. He may be right.

Or perhaps Bush has another motive. Why would he propose such an outrageously expensive plan, basically a massive tax cut that will transfer government money into the coffers of insurance firms? (Don't be fooled--outlawing "cream-skimming" will only jack up rates for the rest of us).

This is an old technique refined by Ronald Reagan and his budget director David Stockman: Spend enough money elsewhere, and you'll be able to resist calls for spending on programs you don't like. "We simply don't have the money. We spent it all on guns."

Bush learned this lesson well. Spend enough money on health care reform-even though other plans would spend less yet ensure better care for more people--and you'll able to turn down proposals for full funding of Head Start, for earned-income tax credits for the working poor, for expanded prenatal care. "We simply don't have the money. We gave it all to the insurance companies."

Uh-oh, there goes the peace dividend. Oh, well. So much for domestic policy.

[Message: let's do lunch with Yeltsin.]

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